Home care and telemonitoring - J. Artur Serrano 2012

Home care and telemonitoring
- Redefining Participatory Design -

Artur Serrano
Leader Research Group
HOPE - HOme care and PErsonalised health
NST - Norwegian Centre for Integrated Care and
Telemedicine

© 2012 NST Artur Serrano

HOPE

HOPE Norwegian UNN
• HOme care & Centre for • University Hospital in
PErsonalized health Integrated Care Tromsø
• 15 members andTelemedicine • Regional (North
• Social Science Norway)
• 100+ people • 4 hospitals
• Health Care
• Research Dep. • Patients treated
• IT
• Consulting Dep . (total) 350K


Tromsø
• Source: http://www.timeanddate.com

• 350 km north of the Arctic Circle

• Tromsø – Oslo: 1155 km
• Oslo – London: 1155 km


The long night in WINTER

The midnight sun in SUMMER


In this talk
1. Home care and telemonitoring
2. What we are doing?
3. Where are we going?


1. Home care and telemonitoring

• Elderly/chronic care
– Ageing population, increased price of hospital
treatment – chronic care and re-hospitalization
• Home care – care at home and Care Homes
• Telemonitoring and telemedicine
• Social care
• Primary care
• IT for health care -> electronic health
• ...


Care services
In the following are my graphical understanding of the concepts involved in Care
Services, and also the Dep. of Health's definitions of the various terms used in this topic
area (RSM web site):
Healthcare Social Care

Telecare – service user to
responder: environmental Telemedicine
monitoring such as fire, flood,
fit and falls in order to ensure
appropriate responses Telehealth
Telehealth – patient to
clinician: vital signs and eHealth
general condition monitoring
such as blood pressure,
weight, mental & physical
state as an aid to treatment of Telecare Home Care
congestive heart failure
Telemedicine* – clinician to
clinician: seeking expert
advice such as a GP
consulting a dermatologist
eHealth – all the above
* I include in this Telehealth as
defined before © 2012 NST Artur Serrano

Before
• Branko G Celler et al. (1999)
– “Very few studies to evaluate the cost effectiveness of
home telecare have been published”
– “Large-scale trials to compare quality of life and
healthcare outcomes of a matched cohort of elderly
subjects … are required to provide evidence”
– “Implementation of home telecare will require
fundamental changes in every sector of the healthcare
services” … “and driven by patient demands for a
greater role in shared decision making”.


Today
• Latest systematic literature reviews in
telehealth:
– “Although home telemonitoring appears to be a promising
approach (…) future studies should consider ways to make
this technology more effective” Paré et al. (2010)
– “limited number of high quality studies with suitable
reference standards” Martin-Khan et al. (2010)
– “There is a need for more detailed, better-quality studies and
for studies on the use of telerehabilitation in routine care”
Hailey et al. (2011)
– “All included studies suffered from methodological
weaknesses” Anna Davies, Stanton Newman (2011)

2. What we are doing

• Medical practice and Business
opportunity
– Better care?
– Evidence on health outcomes
– The big guys
– Who is paying the bills?


Interfaces between levels of care
Processes, processes, ...


Technology that works?
• Technology that works
– Video conference? Panic button?
• Technology that does not (yet) work
– Fall detection, speech recognition,
Integrated Care Services Platforms
• Users motivation
– Are we forcing the elderly to cross the
street?


Challenges
• 6 important challenges in the research field of
“home care for the frail elderly”
– Who are the users? A complex triangulation between
professional carers, informal carers and the care recipients
– Tackling inherent complexity of the elderly health
conditions (e.g. comorbidity )
– Inappropriateness of methods for controlled trials
– Lack of immersion of IT specialists in the actual care
settings
– Incapacity of creating feasible business cases
– Technology (solution or challenge ?) Addressing specific
needs of the elderly target group relating to technology
usability

Possibilities for cruising safely to a
new Home care reality
CRUISE
• C aring scenario
– Who are the users? A fuzzy triangulation of professional carers, informal
carers and the care recipients
• R elate
– Complex health conditions of elderly - e.g. long term, comorbidity
• U nique-User Trial
– New methods for controlled trials
• I mmersion
– Lack of immersion of IT specialists in the actual care settings
• S preading
– Addressing the incapacity to create feasible business cases
• E ndogenous
– Addressing specific needs of the elderly relating to technology usability

C for Caring scenario
• Who is the patient?
• We care for patients, but who cares for
carers?
• “She is my granddaughter!”
• Non-specialised working force
• Multiple actors


R for Relate
• Relate – ”To establish or demonstrate a
connection between”
– Long-term effects -> unfeasible trials due to high
costs and difficult logistics
– Co-morbidity -> confounding variables
– additional outcome parameters -> functional
dependency scales (SF-36, International
Classification of Functioning Disability and Health
ICF, Short Functional Dependence Scale SFDS,
PADL-H, Functional Independence Measure FIM)

U for Unique-User Trial
• Instead of small or large pilots…
• create real services’ trials with ANY number
of users - Yes, 1 user is enough!!!
Pilots and more pilots...

© 2011 NST © 2012 NST Artur Serrano

I for Immersion
• How many researchers in this field have been
in touch with the real care environments?
• E.g. GITWiC [Get In Touch With Care] give care hours
in elderly care instead of money for CO2 compensation

Understand and
try to feel!
What do they feel?


S for Spreading
• Expanding service
• Viral marketing – ”small changes in the
environment lead to huge results”
Andreas Kaplan and Michael Haenlein


E for Endogenous
• Endogenous – ”growing from within”
• NO ”adapt technology to the user”
• YES ”the user is the reason for creating the
technology”
• Universal Design
• The user leads
– When? The start!
– How? Listen
– How often? When decisions must be made
– When stopping? Never

3. Where are we going?
How to shape the future by
novel design of IT in an
evolving world? or "How to
be futuristic when all is
changing so fast"?
Elderly in a research trial

The
Giraff
robot


Where are we REALLY going?!

“Men do not quit playing
because they grow old;
they grow old because
they quit playing.”
Oliver Wendell Holmes


Home care and telemonitoring - J. Artur Serrano 2012

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